Abstract:

A 60-year-old female patient from Longnan of Gansu Province, was admitted to a local county hospital on August 25, 2023, due to fever, fatigue and poor appetite. After completing relevant examinations, she was considered to have hematological diseases. After symptomatic treatments such as blood transfusion and anti-infection, the patient still had recurrent fever. On September 7, 2023, the patient was treated in the People’s Hospital of Gansu Province. Physical examination on admission showed that the spleen was 2 cm below the costal edge, tough and without tenderness. Blood routine showed that white blood cell count was 1.5 × 10⁹/L (↓), red blood cell count was 3.8 × 10¹²/L (↑), hemoglobin was 68 g/L (↓), platelet count was 4.3 × 10¹⁰/L (↓), Ferritin was over 2 000 μg/L (↑), triglyceride was 2.4 mmol/L (↑), fibrinogen was 1.4 g/L (↓) and sluble CD25 was 1 202 U/ml (↑). The results of bone marrow cytological analysis showed that the special macrophages phagocytized living blood cells. Bone marrow smear microscopy showed that some of the macrophages had Leishmania donovani amastigotes in and around the cytoplasm. Combined with the epidemiological history, the patient had long lived in a mountainous area in Longnan of Gansu Province, which is the main endemic area of visceral leishmaniasis in China. The patient was diagnosed with visceral leishmaniasis related hemophagocytic syndrome. After treatment with gluconate (6 ml/d) and dexamethasone (15 ml/d) for one week, the patient had no fever. Reexamination on September 18 showed that white blood cell count was 4.5 × 10⁹/L, red blood cell count was 4.3 × 10¹²/L, hemoglobin was 80 g/L, platelet count was 1.1 × 10¹¹/L and fibrinogen was 1.51 g/L, all of which were higher than those at admission. Five months later, the blood test routine showed that the white blood cells, hemoglobin and fibrinogen returned to normal. Platelets were elevated, but still below the normal range. Abdominal ultrasound showed that the size of the liver and spleen were normal.

Key words: Visceral leishmaniasis, Hemophilic cell syndrome, Hematological disorders